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Postpartum breast cancers pose risks for young women

By Kyle Wagner, The DenverPost

Updated:
10/15/2013 02:06:09 PM MDT

Holly Steinbeck at her Highlands Ranch home on Tuesday, Sept. 17, 2013. Steinbeck, mother of three young children, was still her radiant self a day after starting chemotherapy to fight breast cancer. (Cyrus McCrimmon/The Denver Post)

Soon after Holly Steinbeck gave birth to her first child six years ago, she noticed that one of her breasts was unusually painful.

“I didn't think anything of it,” Steinbeck says. “It was my first time, and I figured, aren't you supposed to be sore?”

When the pain came back after her second child was born two years later, it gave her pause, but again, she imagined it was “just the way it goes.”

When her third baby was born in February, the soreness returned, and this time, it came with lumpy areas.

“The first time, it was sort of like mastitis, a cyclical or burning pain,” the Highlands Ranch resident says. “This time, I thought it was a clogged duct. I got some cream, put it on it, and the doc said, 'I'll see you back in a couple of months.' ”

By July, Steinbeck had been diagnosed with Stage 2b breast cancer, two days before her 30th birthday.

“With no family history, and I'm so young, it just wasn't alarming to anyone,” Steinbeck says. “I don't know what would have happened, when I would have realized.”

According to the American Cancer Society, more than 232,340 women are diagnosed with invasive breast cancer annually. Of those, about 27,000 are women 45 and under, or about 12 percent, and approximately half of those women are postpartum, defined as being within five years of having given birth.

As an oncologist and the director of the Young Women's Breast Cancer Translational Program at the University of Colorado Cancer Center, Borges' self-stated goal is “better outcomes” for young women who are at a higher risk for what are often more aggressive tumors.

In addition, women diagnosed with breast cancer within five years of giving birth are three times more likely to experience a recurrence than those who are outside the postpartum window.

“Losing anyone to cancer is a terrible thing,” Borges says. “Losing a young mom to breast cancer has terrible ramifications on that family.”

The Young Women's program, founded in 2005 by Borges and co-director Pepper Schedin, specializes in the treatment and prevention of breast cancer in women under the age of 45, with an emphasis on pregnancy-related breast cancer.

“Obviously, women can't stop giving birth,” Borges says. “Having children is a part of life. But millions of women give birth every year, and a percentage of them are getting breast cancer, so why? How can we better identify who will be those women?”

To try to figure it out, the Young Women's program has embarked upon a unique, ongoing study of healthy mothers to try to determine risk factors.

“We've asked young women who recently gave birth, after they're done nursing or if they decided not to nurse, to come in for a one-time breast biopsy,” Borges says. “These are women who have never been affected by breast cancer, so that we can see what normally goes on in breast tissue.”

Borges says they were overwhelmed by the response. “The idea of asking a young, healthy woman to come in and give a breast biopsy was a little out there, but I can tell you, these women came out in droves,” Borges says. “We've had 90 women already in a six-month period. Women have understood what their peers have been going through.

“We thought it would take years to get what we need, but I think women have just had enough of watching this.”

Some risk factors for young women already are known, including a family history of breast cancer (having a first-degree relative, such as mother, sister or daughter) and carrying the gene mutations BRCA1 and BRCA2 (getting the $3,000 test done is usually recommended only if there is a family history).

Borges counsels her patients to drop extra pounds, as well, citing recent research that points to 20 percent of cancers being linked to obesity and excess weight. “I harass my patients to exercise, actually,” she says. “If we all had ideal body masses in the normal range, a significant amount of breast cancer would go away.”

The center offers a nutrition program called “Fighting Cancer with a Fork,” which the athletic Steinbeck — who grew up playing competitive sports and has never had weight issues — says she has found helpful.

Steinbeck, who started her first of six rounds of chemotherapy on Sept. 16, initially found Borges during her search for a second opinion and has been following the doctor's advice since.

“I was never a big fish-eater,” she says. “I've been working hard at making sure the whole family doesn't eat things with carcinogens in them and increasing the antioxidant foods, and eating tons of things like broccoli and red peppers, grapefruit, a cup of something red a day.”

Steinbeck also is participating in several studies at the center.

“At this point, I would do just about anything I can do that doesn't hurt me to help make sure other women don't have to go through this,” Steinbeck says. “Imagine if my baby girl didn't have to deal with any of it.”

Postpartum breast cancer risk

Understand that pregnancy is a risk factor for breast cancer

Be aware of any changes in your breasts, and contact your physician quickly, particularly if these changes occur after pregnancy or weaning

Get a breast exam as part of your six-week postpartum visit

Follow the American Cancer Society guidelines for mammography screenings: Annually beginning at age 40; women with a family history should begin screenings 10 years younger than the earliest age anyone in the family was diagnosed. (It is not recommended that women get screening mammograms earlier, as the technology is not proven effective at detecting cancer in these women.)

Source: The Young Women's Breast Cancer Translational Program at the University of Colorado Cancer Center

Study of pregnant or newly nursing moms

The University of Colorado Anschutz Medical Campus is collecting breast tissue of healthy women to use in a comparison study of women with breast cancer. To participate, visit tinyurl.com/mothersstudy or call 303-724-0186.

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